Med Surg

localized or general loss of hair

Discoloration (yellow) of skin, most noticeable on palms & soles. From veggies (carrots & squash) & hypothyroidism

Bluish-gray or purple discoloration caused by presence of excessive amts of reduced hemoglobin in capillaries

Extravasation of blood of sufficient size to cause visible swelling from trauma or bleeding disorders. (Bruise)

Loss of pigmentation resulting in lighter patches than a normal skin color. Caused by chemical agents, nutritional factors, burns, inflammation, & infection

yellow or yellowish-brown discoloration of the skin, best observed in sclera, secondary to increased bilirubin in the blood. Caused by liver disease, RBC hemolysis, pancreatic cancer, common bile duct obstruction.

Failure of skin returning to normal position immediately after gently pinching. From aging, dehydration, or cachexia

Examine skin lesions for Asymmetry, Border irregularity, Color change/ variation, Diameter of 6 mm or more, and Evolving in appearance

Exam of skin w/ long-wave UV light causes specific substances to fluorescence.

Used to determine whether pt is allergic to specific testing material. Small amt of potentially allergenic material applied, usually to skin on back

Hemolytic strept or staph associated with poor hygiene. CONTAGIOUS. Thick, honey-colored crust most common on face. TREAT WITH ABX

Deep infection around hair follicle associated w/ severe acne. Tender, pus-filled areas on face, back of neck, axillae, breasts, butt, thighs, & perineum. Extremely painful. TREAT W/ ABX

Multiple interconnecting furuncles. Most common on nape of neck. Pustules

inflammation of SQ tissues following break in skin. Can progress to gangrene. TREAT W/ ABX, pt on contact precautions

Oral and genital. Life-long viral infection that effects skin and mucus membranes when exacerbated by sunlight, trauma, menses, stress, & systemic infection. TRANSMITTED BY RESP DROPLETS.

Increased with age. Potentially contagious. Resembles chickenpox. Activated from varicella-zoster virus.

Caused by HPV. Wart on bottom surface of foot, growing inward. Painful when pressure applied

Caused by candida albicans. Presents in warm, moist areas causing yeast to become pathogenic.

Ringworm. Ringlike, scaly appearance w/ well-defined margins

Jock itch. Well-defined scaly plaque in groin area. Does not effect mucus membranes.

Athlete's foot. Interdigit scaling & maceration

Increased w/ age. Effects finger & toe nails creating scaly, brittle, thickened, broken/ crumbling nails w/ yellow discoloration

Feeding, usually at night. Wheal transforming into persistent lesion. Severe itching. Teach about hygiene. Fumigate home.

Parasites that suck blood & leave eggs and waste on skin & hair. Leaves small red points & severe itching. Occurs around back to school time

Mites that penetrate stratum corneum, deposits eggs. Transmission by direct physical contact, presence of burrows.

Causes Lyme disease. Spreads ringlike rask 3-4 wks after bite. Looks like a bulls-eye causes flu-like symptoms

Any rash w/ abrupt onset. Treat w/ antihistamines & corticosteroids (Benadryl is most common)

Inflammatory disorder of sebaceous glands. More common in teens. Corticosteroids can cause flair

Grouping of norm cells derived from melanocyte-like precursor cells. Hyperpigmented areas (flat, raised, or hair)

Autoimmune chronic dermatitis causing silvery scaling plaques

common after midlife. Small, skin-colored, soft papules. Caused by high cholesterol

Used both topically & systemically. Common OTC= Neosporin, bacitracin, & polymyxin. Prescription= mupirocin, gentamicin, & erythromycin

Topical=inflammation & itching. Corticosteroids can alter manifestations so dx before admin.

Treats uticaria, angioedema, & pruritis. Warn about sedative effects. Claritin, Zyrtec

Done with scalpel blade for microscopic inspection and dx

scooping and removal of tissue w/ instrument w/ a circular cutting edge. Tissue sent for biopsy

Obtains tissue sample for study or removal of small lesion. Punches deep into flesh & tissue and placed in preservation solution

• Main receptor HIV binds to. Pt can be asymptomatic for 10-12 years while HIV levels remain low in blood.
• Norm values: 800-1200

Contraction of myocardium, resulting in ejection of blood from ventricles

relaxation of myocardium, resulting in filling of ventricles

amt of blood pumped by each ventricle in 1 min

vol of blood in ventricles at end of diastole, before next contraction

Peripheral resistance against which the left ventricle must pump.

Can be increased by epi and norepi released by SNS. Increasing contractility raises the SV by increasing ventricular emptying

Located in aortic arch & carotid sinus. Sensitive to stretch or pressure in arteries. Stimulation inhibits SNS & influences PNS. Decreasing arterial pressure causes opposite

located in aortic & carotid bodies. Capable o initiating change in HR & arterial pressure in response to increased arterial CO2 pressure (hypercapnia) & decreased arterial O2 pressure (hypoxia) & decreased plasma pH (acidosis)

Difference between SBP & DBP. Normally about 1/3nof SBP. Increased= exercise or atherosclerosis. Decreased= HF or hypovolemia

Avg pressure in arterial system that is felt by organs of body. Map>60. MAP=(SBP+2DBP)/3

BP: 120/80, HR: 60-80, RR: 12-20, Temp: 97-99

jugular vein distention. Can be caused by R sided HF

0=absent, 1+=weak, 2+=normal, 3+=bounding

Turbulent flow sound in artery caused by obstruction or aneursym

Turbulent sounds occurring between normal heart sounds caused by valve disorder or abn blood flow patterns.

Mechanical clicking noise caused by a mechanical valve

High-pitched, scratchy sound heard during S1 &/or S2 at the apex. Heard best w/ pt sitting & leaning forward & at end of expiration. Caused by pericarditis

Raised notch where 2nd rib meets sternum

Bluish/ purplish tinge along center such as tongue, conjunctiva, inner mucosa of lips. Caused by inadequate O2 sat of arterial blood from pul or cardiac disorders

Bluish/ purplish tinge in extremities or nose & ears. Caused by decrease in blood flow due to HF, vasoconstriction, cold environment

released into circulation as byproduct of myocardial cell injury or death

myocardial muscle protein released into circulation after injury. Any rise is dx of myocardial injury. Troponin I=<0.5. Troponin T=<0.1

enzymes released by heart. 6 hrs after onset of symptoms, peak in 18 hrs, & return to norm 24-36 hrs after MI

records electrical cardiac activity from different views. Can detect: rhythm, abn condition, size of atria & ventricles, PM activity, heart position, Hx of MI, presence of injury

uses 3 min stages at set speeds & elevation of treadmill to get pt to target HR

Results from inability of heart to pump blood effectively. Caused by impaired contractile function, increased afterload, cardiomyopathy, & mechanical abnormalities. Decrease in EF

Inability of ventricles to relax & fill during diastole. Decrease filling of ventricles results in decreased SV & CO. Characterized by high filling pressures & engorged veins in pulm & systemic vascular systems

enlargement of heart chambers due to long term elevated pressure in heart chambers. Decreased CO

Increase in muscle mass & cardiac wall thickness in response to overwork & strain. Occurs slowly b/c it takes time for increased muscle tissue to develop.

Results from L ventricular dysfunction causing blood to back up into pulm veins manifesting into pulm congestion & edema

Increased HR, Decreased PaO2, slight increase in PaCO2, crackles, pleural effusion, change in mental status, confusion, restlessness, dyspnea

causes back up of blood into venous circulation. Venous congestion results in JVD, hepatomegaly, splenomegaly, vascular congestion of GI & peripheral edema. Primary causes is L sided HF

Murmurs, JVD, Edema, weight gain, Increased HR, ascites, fatigue, anxiety, anorexia, N/V, RUQ pain

Diuretics to decrease venous return & amt of blood returned to LV during diastole. Vasodilators to decrease circulating vol by decreasing preload & increasing coronary artery circulation by vasodilation

decrease preload & afterload & frequently used to treat ADHF & pulm edema. Dilates both pulm & systemic blood vessels to decrease pulm pressure & improve gas exchange

Increased myocardial contractility. Digitalis improves LV dysfunction & increased contractility & myocardial O2 consumption

SBP <120 & DBP<80

SBP 120-139 or DBP 80-89

SBP 140-159 or DBP 90-99

SBP (> or = to) 160 or DBP (> or = to) 100

Alcohol, cigarette smoking, DM, elevated lipids, excess dietary sodium, obesity, sedentary lifestyle, stress

Age, gender, FmHx, ethnicity, socioeconomic status

HTN effects endothelium resulting in stiffened arterial wall & a narrowed internal lumen

Sustained high BP increases cardiac workload & produces LV hypertrophy. It is initially an adaptive or compensatory mechanism but over a long period of time, the heart can no longer meet the demand & HF develops

occurs when hearts compensatory adaptations are overwhelmed & the heart can no longer pump enough blood to meet body's needs

Atherosclerosis is most common cause of cerebrovascular disease. Risk of stroke 4x higher

Atherosclerosis in peripheral blood vessels caused by HTN that leads to PVD, aortic aneurysm, & aortic dissection

HTN causes end-stage renal disease, especially in African Americans. Narrowed lumen cuses ischemia. Intrarenal

Indication of concurrent vessel damage in the heart, brain, & kidneys

diet that emphasizes fruits, veggies, fat-free or low-fat milk & milk products, whole grains, fish, poultry, beans, seeds, & nuts. Significantly lowers BP (AKA cardiac diet)

1. decrease vol of circulating blood. 2. decrease SVR (systemic vascular resistence)

promote Na+, H2O excretion, decrease plasma vol, & vascular response to catecholamines

Diminishes SNS effects that increases BP

Decreased BP by relaxing vascular smooth muscle & decreased SVR

Increased Na+ excretion & causes vasodilation by preventing the movement of extracellular Ca+ into cell. Causes decreased HR, contractility, & stroke volume

Reduce A-II mediated vasoconstriction & Na &H2o retention

soft deposits of fat that harden with age

Arterial anastomoses that exist w/in the coronary circulation

A. Damaged endothelium. B. Diagram of fatty streak & lipid core formation. C. Diagram of fibrous plaque. Raised plaque visible (yellow or white). D. Complicated lesion: thrombus is red, collagen is blue

CP when demand for myocardial O2 exceeds the ability of the coronary arteries to supply the heart w/ O2, causing myocardial ischemia

CP that occurs at rest, usually in response to spasm of a major coronary artery

• A. antiplate (ASA)/ Anticoag, Antianginal (Nitro), ACE inhibitor/ ARB
• B. Beta-blocker
• C. Cigarette smoking, CCB
• D. Diet, DM
• E. Education, Exercise
• F. Flu shot

Chronic condition resulting from rheumatic fever that is characterized by scarring & deformity of the heart valves

Constriction or narrowing of valve

incomplete closure of valve leaflets resulting in backward flow of blood

Abnormality of mitral valve leaflets & the papillary muscles or chordae that allows leaflets to prolapse or buckle, back into the L atrium during systole

constituted as life-threatening emergency

Persistent but variable inflammation of the airways. Caused by exposure to allergens or irritants initiates the inflammatory cascade

not fully reversible airflow limitation during forced exhalation caused by loss of elastic recoil & airflow obstruction

• 1. airway limitation
• 2. gas exchange abnormalities
• 3. Air trapping
• 4. Mucus hypersecretion
• 5. Severe disease pulm HTN
• 6. Systemic features

onset <40, presence of allergies, intermittent symptoms, dyspnea absent except in exacerbations, stable disease coarse.

onset 40-50, long history of smoking, infrequent allergies, symptoms are slowly progressive or persistent, dyspnea during exercise, disease coarse gets progressively worse.

Often normal-low pH & PaO2; normal-high PaCO2 w/ high HCO3 (comp resp acid)

Max vol of air lungs can contain. norm=6.0L

vol of air inhaled & exhaled w/ each breath. Only a small portion of TLC. Norm=0.5L

Amt of air remaining in lungs after forced expiration. Norm=1.5L

• Symptoms </= 2 days a week
• Nighttime awakenings </= twice a month
• No interference/ norm activity
• SABA use </= 2 days a week
• FEV, or peak flow >80%

• Symptoms >2 days a week
• Nighttime awakenings 1-3/ wk
• Some limitations during norm activity
• SABA use > 2days/wk
• FEV, or peak flow 60-80%

• Symptoms throughout day
• Nighttime awakenings>/= 4/wk
• Extremely limited normal activity
• SABA use several times per day
• FEV, or peak flow <60%

Airway clearance device that causes airway fluttering which loosens mucus

connected to pulse-generator thru hoses. Generator delivers air which vibrates the chest, dislodging mucus from airways

vibrate hand on chest wall during slow expiration which facilitates movement of secretions to larger airways

short acting beta2 adrenergics. Inhaled is most effective for relieving acute bronchospasm

Metered dose inhaler. Small hand-held, pressurized device that delivers a metered dose of drug w/ each activation